Who Wants to Save a Junkie?

Oregon can, with one simple step. So far, it hasn’t.

REDUCING HARM: “What we’re dealing with is a population of individuals who’ve gotten involved with a very dangerous drug,” says Dr. Gary Oxman, recently retired health officer for Multnomah, Washington and Clackamas counties. “We can pull them out of that. We should do that. These folks are our brothers and sisters.”

IMAGE: Anna Jaye Goellner

Dr. Gary Oxman spent his career trying to save people who don’t care whether they live or die.

Oxman—who just
retired as health officer for Multnomah, Clackamas and Washington
counties—has long wanted to do more to rescue drug users.

He was one of the
earliest supporters in Portland of free needle exchanges, aimed at
stopping the spread of HIV among addicts who share syringes. That idea,
first floated in the late 1980s, was often met with derision: Why should
we condone the use of dangerous drugs by making it safer for addicts to
keep shooting up?

Oxman
helped champion a needle-exchange program in Portland, and he says it’s
the reason the city never saw the explosion of HIV among drug users as
other communities did.

“Pure and simple,” Oxman says. “Something that went very right.”

But Oxman, who retired last month, has been unable to reverse another epidemic: opiate addiction.

In Oregon,
unintentional drug overdoses now kill more people than car accidents.
The drugs that are driving up those numbers and killing most often are
opiates—heroin and prescription pain medication, including methadone. In
2011, Oregon saw nearly 300 people die because of opiate overdoses—the
highest year yet for heroin deaths. The rate of people dying from
opiate-related overdoses has more than tripled in the past decade.

In fact, Oregon has the highest rate of opiate abuse among people under 25 than anywhere else in the country.

More than half the drug overdose deaths in Oregon are linked to prescription opiates such as OxyContin and Vicodin.

In Multnomah County,
the top killer is heroin. Nearly half of drug users addicted to heroin
here say they got hooked first by taking prescription pain pills.

Gov. John Kitzhaber has called the state’s addiction to these drugs “calamitous.”

Oregon has tried to battle drug addiction with education and treatment programs.

But Oxman wants the state to go further.

He wants to expand the use of another drug that will snap users out of an overdose of heroin, methadone or pain pills.

It’s commonly called
Narcan, and for more than four decades paramedics and emergency-room
personnel have injected it into people dying of opiate overdoses to give
them a chance to hang on.

Across the country,
recovery agencies and treatment centers have been making Narcan (also
known by its generic name, naloxone) available to drug users’ friends,
families, counselors and even addicts themselves—giving them a chance to
deliver a life-saving dose before paramedics arrive.

Considered radical
when it started, the wider use of Narcan has saved as many as 10,000
lives by reversing the effect of overdoses.

But Oregon—once in the forefront of helping protect the health of drug addicts—has not joined in.

Now, Oregon senators
are considering a bill to make it easier to distribute Narcan. By doing
so, lawmakers will shift the state’s efforts to fight drug overdoses not
just with education, prevention and treatment, but by giving addicts a
safety net even as they practice self-destructive behavior.

“These overdoses are
individual and community tragedies,” Oxman says. “They can be treated,
and so we don’t need to have people dying needlessly.”

NARCANNED: John Sanborn, in a Portland recovery program run by Central City Concern, says medical personnel have used naloxone on him during at least three of his many heroin overdoses. “It takes you out of the nod,” says Sanborn (who asked that his face not be photographed). “It saves lives. It probably saved mine.”

IMAGE: Anna Jaye Goellner

A native of Minneapolis, Oxman came to Oregon after
graduating from the University of Minnesota Medical School in 1978. When
he was in private practice in the early 1980s, he recalls seeing
patients he suspected were describing problems with pain that didn’t
exist.

“They were trying to
manipulate me into giving them opiates,” Oxman, 60, says. “That’s always
been there in the community. It’s just way worse now than it was a few
decades ago.”

Oxman was named
Multnomah County medical director in 1984, and the county’s public
health officer three years later. Around 2000, Oxman helped reverse the
spike in heroin deaths, in part by targeting addicts themselves with
information about how to use the drug more safely.

The overdoses the
Portland area sees now are not driven by heroin alone. The long line of
drug deaths often begin at the prescription pads of doctors.

Nearly half of the
prescriptions tracked by state officials last year were for opiates.
That amounted to 3.7 million painkiller prescriptions—nearly one for
every resident of Oregon.

Drug users say
painkillers lead to addiction—43 percent of heroin users in Multnomah
County say they were first hooked on prescription painkillers. (Heroin
is often cheaper and easier to get than prescription drugs.)

These drugs have
created a widespread occasion of death. More than 60 percent of current
opiate abusers say they’ve seen someone overdose in the past year.

“The docs are sort of
trapped in this situation where patients are in pain and there’s no
logical alternative,” Oxman says. “It’s not bad doctors. It’s the
structure of the health-care system that’s really driving this.”

Tom
Burns, director of pharmacy programs for the Oregon Health Authority,
says in many cases physicians and dentists overprescribe pain meds to
avoid having to write repeat prescriptions.

But Burns says the
state has no intention of challenging physicians’ autonomy when it comes
to making medical decisions. “We’re not Big Brother,” Burns says.

Instead, the state
has tried educating doctors. In 2009, the Oregon Legislature created the
Oregon Prescription Drug Monitoring Program, intended to help
physicians track their patients’ prescriptions, no matter who writes
them. A medical professional who’s concerned about a patient’s use of
OxyContin, for example, can log on and see if the patient has been
“doctor shopping” by getting prescriptions from other sources.

Ryan Lufkin is a
deputy district attorney in Multnomah County who focuses primarily on
drug crimes—he estimates he’s handled 1,100 drug cases in the last three
years. He says too little money spent on recovery and treatment
programs makes matters worse.

“The solution that
seems to be the gold standard from a criminal-justice perspective is a
treatment bed straight from a jail bed,” Lufkin says. “The ultimate goal
is not conviction, but treatment.”

Last fall, Vero Majano came to Portland to help organize a
film festival at the national convention of the Harm Reduction
Coalition, an organization that works to help protect the health—and the
rights—of people who use drugs.

Majano manages a
drop-in center for the homeless in the Mission District of San
Francisco. A social activist for years, Majano says most people don’t
understand the goal of harm reduction—in part because they demonize the
drug-using community.

“There’s this thing
around drug use being evil,” she says. “So the idea is that drug users
are also bad. If people were to look at trauma, how people
self-medicate—people use [drugs] for good reasons.”

Majano’s views
reflected the message at the conference, which drew hundreds from around
the country: Drug users should have no fewer rights to have their
health and welfare protected than anyone else.

Yet proponents say
society should do more than simply jail people who use drugs, or try to
combat addiction through education and treatment programs. It also means
helping keep addicts alive and healthy, even when they show no signs of
stopping their drug use.

Take the case of Jake Rhew.

“JAKE WAS DESPERATE”: Supporters of expanding the use of Narcan (also known as naloxone) say the drug might have helped snap Jake Rhew out of his heroin-induced stupor in August 2011. He died while in a residential center that, under current state law, didn’t have access to the drug.

Rhew
was born in Pullman, Wash., in 1982, and attended Sam Barlow High
School in Gresham. His family recalls Jake as a kid who loved to fish,
raft the Clackamas River and stood up for people who were powerless—even
as a kindergartner, he protected other kids from school bullies.

Before he was out of high school, Rhew got hooked on pain pills and stole medication from his family.

Rhew earned a GED
diploma and enlisted in the Army National Guard, only to get kicked out.
He moved to his father’s house in Troutdale, stole to buy drugs, and
tried to hide track marks on his arms. From 2009 to 2011, Rhew was
arrested and charged five times for theft and once for possessing
heroin.

“Jake was desperate,” Thomes-Rhew says. “It wasn’t the Jake we knew, and that’s what heroin can do to a person.”

Rhew often recorded
his battle with drugs on his Facebook page. “5 months sober,” he wrote
in June 2010. Two weeks before his last overdose, he wrote, “Damn going
to sleep is a lot harder then [sic] passing out.” And three days
before he died, he posted a photo of himself: short-cropped blond hair,
broad nose, clean white T-shirt, cautious smile. “Lookin’ good Jake,” a
friend wrote.

On Aug. 23, 2011,
Rhew, 29, was living at the men’s residence center run by Volunteers of
America in Northeast Portland when he and another client slipped into a
bathroom to shoot heroin. Rhew was already in full nod by the time the
center’s staff found him.

They couldn’t revive him and he choked on his vomit. It’s the center’s only death.

“The counselors did
everything that could be done,” Thomes-Rhew says, but the staff didn’t
have access to Narcan. “At least he would have had a chance.”

Greg Meenahan,
director of development and communications for Volunteers of America,
said medical privacy rules prevented him from talking about Rhew’s
death. But he says he would want Narcan in the hands of the
organization’s staff.

“We view this as a
life-saving medication,” Meenahan says. “If we were able to have it,
there’s little doubt that we would use it.”

Narcan is a brand
name for naloxone, developed in New York in 1960 by researchers who
found the drug had a remarkable ability to block the effects of heroin
and other opiates.

The use of Narcan
isn’t quite as dramatic as perhaps the most famous scene of reviving
someone in the throes of a drug overdose: the stabbing of Uma Thurman’s
character in the heart with an adrenalin-filled hypodermic needle in
Quentin Tarantino’s Pulp Fiction.

The drug is often
injected into the skin or a muscle, such as the biceps or thigh, and
also comes as a nasal spray. Narcan throws the overdose into
reverse—people can go from being blue and not breathing, to gasping for
air in an instant withdrawal.

John Sanborn knows how it feels.

He says he’s been
“Narcanned” by paramedics during heroin overdoses. Like the time he
cooked up shot after shot in a Portland State University restroom. Or
the time other junkies dragged him into a downtown apartment hallway and
left him for dead.

“It’s horrible if
you’re living with an addiction,” Sanborn says of Narcan’s effects. “It
brings you right down to where you were before you started shooting.”

Narcan, Sanborn says,
gave him a new chance at recovery. He’s currently in Central City
Concern’s Community Engagement Program and is reconnecting with his
9-year-old son. “I realized that if I ever wanted to have any kind of a
life,” he says, “I was going to have to stop using drugs.”

Sanborn got Narcan
the way almost everyone in Oregon does: from a medical professional. But
nearly 20 years ago, activists in other states realized the greater
potential of the drug to save lives.

“[We] turn to the
next big issue, which is overdose,” Bigg says. “Why not use the existing
pathways to get [Narcan] into the hands of people who overdose?”

In 1996, Bigg’s
organization began to train and distribute naloxone to laypeople. He
says he has administered naloxone to an overdosing person at least six
times.

In 2010, Illinois
finally made it legal to do what Bigg’s group had been practicing, but
he says he’s frustrated that other parts of the country are behind.

“It’s a pure antidote,” Bigg says, “and you’d think it’d be available to scores of people suffering from premature death.”

By that time,
according to the Centers for Disease Control and Prevention, the use of
Narcan by nonmedical professionals had broadened: Nearly 200 programs in
15 states and the District of Columbia were making Narcan more
available. A 2012 CDC report said these programs helped reverse the
effects of drug overdoses in more than 10,000 cases.

The CDC also found
“many states with high drug-overdose death rates have no opioid-overdose
prevention programs that distribute naloxone.” That includes Oregon.

Allan Clear,
executive director of the Harm Reduction Coalition in New York, says
Narcan should be ubiquitous, especially in a city like Portland that has
an opiate-overdose problem and has been a leader in needle exchanges.

“Overall,
nationally, it’s not that well-known as a community intervention
program,” Clear says. “In New York City and San Francisco—when the
health department got on board—it really added that level of legitimacy
to it. There’s always been this level of caution because naloxone is one
of those drugs you prescribe to use on someone else.”

“In New York, we
actually have it set up so different kinds of agencies can distribute it
to whoever they want,” she says. “It has gone from being this sort of
edgy thing to really becoming mainstream.”

Dr. Sandro Galea,
chairman of the epidemiology department at Columbia University, says
Narcan was controversial in New York because people believed making it
widely available would encourage drug users to indulge in opiates.

Galea’s studies showed that drug users were not encouraged to be more reckless with heroin by having Narcan handy.

“There is no excuse for not making naloxone widely available to the [drug-using] community,” Galea says.

HARM-REDUCTION REDUX: Kathy Oliver, executive director of Outside In, says her organization supports making naloxone, commonly known as Narcan, more available. While advocating for harm-reduction efforts to help drug addicts in the past, such as free needle exchanges, Outside In has not advocated for expanded use of naloxone as other organizations have elsewhere.

IMAGE: Anna Jaye Goellner

If drug-overdose deaths are so common here, why is Oregon so far behind in the movement toward Narcan?

Oxman says cities and
states that moved ahead with making Narcan more available also have
more vocal and organized groups advocating for the welfare of drug
users.

“I think when you get
a critical mass of folks who believe in a particular issue, that makes
organized action easier,” Oxman says. “It’s not that Portland lacks the
drug users—we have lots and lots of drug users.

“Government
is not in a position to be the leaders of harm reduction. It’s really a
community activity. And it is really bewildering why that hasn’t been
more prominent here.”

In
Portland, the organization that helped pioneer the needle-exchange
program, Outside In, has been the obvious place to experiment with
making Narcan more available.

Outside In works with
homeless youth and what it calls “marginalized people.” Kathy Oliver,
Outside In’s executive director, says health-care workers in the
organization’s clinic on Southwest 13th Avenue near Main Street are
allowed to both inject and prescribe Narcan to people for use only on
themselves.

Oliver would like to
see Narcan more widely available. “The reason I want to do it is the
same reason I wanted to open the syringe-exchange program,” she says.
“Death by overdose is preventable, so giving people the means to protect
themselves makes sense.”

But Outside In has
been largely silent on the issue, despite the high overdose rates in
Multnomah County. Oliver says she’s aware that scores of other
organizations like hers around the country have distributed Narcan or
promoted its use.

“We
did think the best way to achieve [a community pathway for naloxone]
would be through the legislative and not through Outside In being a
political advocate,” she says.

In Salem, state Sen.
Alan Bates (D-Medford) has introduced a bill to expand access to Narcan.
Jackson County, where Bates lives, saw 30 people die in 2012 from
opiate drug overdoses, according to Dr. Jim Shames, the county health
officer.

Ashland, a community
known for staging the Oregon Shakespeare Festival, was stunned recently
by the death of three men within six weeks of each other—all from opiate
overdoses.

Maxwell Pinsky, 25,
the son of a local blues musician, died Jan. 15 of a suspected opiate
overdose; the Jackson County sheriff’s office says the toxicology
reports aren’t finished yet. A month earlier, Ashland had two
heroin-overdose deaths within a day of each other: Pinsky’s friend
Jordan Roth, 34, the son of a retired physician; and Colin McKean, 36,
son of actor Michael McKean.

Bates’ bill would
make Narcan a drug that anyone—from social workers to drug users—can get
training to use and be able to purchase to have with them in the case
of an emergency. Part of the bill also makes people who administer
Narcan in an overdose situation immune from civil prosecution.

Emergency-room
physicians have warned legislators the drug can cause a powerful
reaction in people coming out of an overdose if the dosing isn’t done
properly.

Oxman says passage of
the bill will mark a big step in Oregon moving toward accepting the
idea that government has a role to play in helping drug users stay
alive, regardless of whether they stop using.

“I think people have
really come around,” he says, “to seeing what we’re trying to do is help
people who have problems with drug abuse, and there’s a variety of
different pathways to get there.”

"In the low usage areas, we found that our vehicles sit idle four times longer, ultimately affecting overall vehicle availability for the Portland membership base, as well as parking for the Portland community."

News
East Portland can't catch a break.Just this week KGW had a story called, "Diverse, non-cool East Por... More